When graduating residents and fellows begin their careers as attending doctors, there is a wealth of financial advice out there. Grow into your salary slowly. Don’t buy a house right away. Get disability insurance. Plan ahead for the tax bomb that always takes attendings by surprise during that half-trainee/half-attending year.
Today, we won’t discuss any of those. We’ll focus instead on a business lesson that you must unlearn when you graduate from residency: How to be a good soldier.
Learning to be a good soldier is drilled into you throughout your medical training. In residency, you accept the trainee salary they give you without complaint, and asking for a raise is not an option. You are taught to be proud of the ungodly number of hours you work and to take it all in stride. Someone made a scheduling snafu, and your last night shift bleeds into a long day shift? You tough it out, do it with a smile on your face, and show no weakness until you collapse in the privacy of your own home. Those who do this better than anyone become chief residents and prime candidates for fellowship.
Throughout your training, you are rewarded for your endurance, your resilience, your stoicism, and your ability to exceed even the most extreme expectations. But when you become an attending, the same attributes can become a liability.
If you never express dissatisfaction, necessary changes will never come.
If you never say no to added work or added shifts, the predictable outcome will be exhaustion or burnout.
If you always do the job others want of you, you will never take charge of your own career.
If you never question the accounting of your compensation, you will neither learn nor get paid what you are worth.
When you become an attending, you must learn to adopt a new self-image. No longer should your idealized persona be the stoic, indefatigable soldier who never disappoints. Instead, I encourage you to adopt an extremely different and perhaps uncomfortable persona: I am the CEO of my own business. For private practice physicians who will own their practices, this will literally be the case. But even for physicians who are W-2 employees, this mindset will change everything.
Try saying the following sentences out loud. The first sentence reflects the old mindset, and the second sentence reflects the new mindset.
Old mindset: “I am a physician at [your practice].”
New mindset: “I am the CEO of my own business, and one of my current clients is [your practice].”
Notice the difference? Before, you were a member of a team, and your job was to serve the needs of that team. Now, you work in a win-win relationship with that team, and you are both vested in mutual professional satisfaction. There are a few important implications here.
1. Never accept a professional relationship that is not win-win. If a health practice were to make an unreasonable demand of a good soldier, he would grit his teeth, take one for the team, and get the job done. But a CEO would say to her client, “I’m not sure how the professional relationship you are proposing is mutually sustainable. Can we discuss further?” If this feels uncomfortable to say, ask yourself whether your employer would have any problem letting you know if some aspect of your employment was not satisfactory to them. There is no reason you shouldn’t do the same.
2. Always protect your relationship with a great client. By no means am I telling you to be self-centered or to reject being a team player. That would be the easiest way to lose a great client who deserves better. A win-win relationship is not just an expectation you should have, it is a responsibility for you to maintain. That work ethic, the grit and the commitment to quality you learned in training? Use it, but own it as part of your brand. Adapt that old med student drive to exceed expectations by asking yourself: “How can I add more value for my client? What pain points does my client have that I am uniquely capable of addressing?” This protects your business by minimizing the chance that your client will be the one who terminates your relationship first.
3. Having more than one client gives you more options. What happens if a great client does terminate your relationship? Like all businesses, you’re more resilient if you have more than one client you depend on for income. You live in a free market economy. There is no rule that you can’t work with multiple clients at once, as long as you are capable of sustaining that win-win relationship for your clients. Your personal business could take on a different medical practice client, an expert witness client, an asynchronous telemedicine client, a pharmaceutical or industry client, or a non-medical consulting client. Keep this in mind when you are signing a contract that has a non-compete clause, a clause prohibiting you to work for anyone else while employed, or a clause that gives them ownership of anything you create while employed. These clauses are specifically designed to take away your power to have other clients or walk away from a relationship that is not win-win.
So let’s recap:
You are now a CEO of your own business, not someone else’s good soldier.
You don’t have an employer—you have a professional client with whom you will only accept a win-win relationship, and you will work fiercely to protect it once you have it.
Feel free to work with more than one client. Never sign a contract that takes that option away.
Stanley Liu is a cardiologist.
